Picture of Domhnall MacAuleyDomhnall MacAuley is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK


You step off the podium into an abyss. And, that’s if you have been a success. For everyone who competes at top level, medallist or not, the transition is dramatic. If your sporting career has come to a sudden end due to injury, poor performance, or you are unexpectedly dropped from the team, there can be an overwhelming sense of failure or unfulfilled ambition. No one sees what happens when you leave the stage. Adjusting to the real world can create huge challenges for former athletes and often, the greater the success, the more difficult to readjustment.

Gearoid Towey, a four-time Olympic rower and former World Champion, founded an organisation called ‘Crossing the Line‘ to help athletes deal with retirement. Their mission is to support athletes in the next stage of their lives.

Sport is a tough, mean and ruthless business. Elite level sport is a full time occupation and, even if you are not paid, it demands enormous commitment, determination and single mindedness. There are rewards, of course, in personal achievement, a sense of value and, increasingly, financial benefit. But, there is also a cost. Every sports career ends long before the retirement age in any other job. So, what do you do with the rest of your life? While you were committed to sport, others had been moving on, building their careers, getting on the property ladder, and starting a family. While you chased medals and glory, others earned money and progressed in their work. They may have cheered from the side line but they didn’t wait around. There are opportunity costs to every sporting career.

So, where does sports medicine come into it? Sadly, injury may be part of the legacy. The current emphasis within sports medicine is on prevention of injury and rapid return to sport. There can be a conflict, however, in that rapid return may not be optimum return. What may be best for the team may not be best for the individual athlete. Managers, coaches, and support staff are performance focused and pressure for results may encourage doctors to take short cuts. Inject a joint, ignore a problem, play someone with an injury. Doctors are dispensable and may be seen as obstructive if they hold back a player that is needed for the team- and soon find themselves substituted. There may be tension between what is best for the athlete in the long term and short term benefits for the team. It is important that doctors are not part of the problem.

Sporting organisations provide supportive environments that foster team success. But, when an athlete leaves or retires, they often lose their links with that support infrastructure. They lose their professional and personal identity and they may also lose contact with professional staff. And, there are casualties. Life as a top athlete is an extraordinary privilege: you’re féted, cossetted, living in bubble and programmed for achievement. Retirement means never ever recapturing the glory and adrenalin-rush of past competition and it’s hard becoming an ordinary person. Psychological adjustment can be difficult and many athletes struggle with this rapid and enormous personal transition. There is now increasing awareness of subsequent difficulties including substance abuse, depression, and relationship problems. Dr Alan Currie, a psychiatrist with an interest in sport and exercise medicine and, in particular the stress of top sport, has created a useful website that he hopes will become an important resource for dealing with athletes during and after their sports career.

It’s over. What will you do on Monday morning? Nothing, unless there has been considerable advance planning. Sporting organisations, which benefit directly from the huge commitment from athletes, have a responsibility to help athletes plan for the future. They need to look at post career opportunities, education and training, financial planning, self-awareness of coping with change and loss of identity. Medicine also has a role in highlighting athletes’ wellbeing as, in some cases, there can be significant medical and psychiatric problems.

Life after sporting achievement may, for some, be a much greater challenge than winning medals.